Provider Demographics
NPI:1144665381
Name:PARK, JILL OWENBY
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:OWENBY
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-9023
Mailing Address - Country:US
Mailing Address - Phone:615-740-5775
Mailing Address - Fax:615-797-6400
Practice Address - Street 1:377 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9023
Practice Address - Country:US
Practice Address - Phone:615-740-5775
Practice Address - Fax:615-797-6400
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant